Epithelial Thickness Changes After Descemet Membrane Endothelial Keratoplasty (Dmek): A Retrospective Study

To investigate epithelial thickness patterns in post-DMEK patients using anterior segment optical coherence tomography (AS-OCT) and assess the correlation between age and the inferior-superior (I-S) epithelial thickness difference.

A retrospective study conducted at the Sussex Eye Hospital.

Forty-two post-DMEK patients (42 eyes) and nineteen healthy controls (36 eyes) were included. Three-dimensional corneal epithelial maps were obtained ausing the Solix OCT system. Epithelial thickness was taken at the last follow-up (mean of 9.48± 8.41 months, range 1-29) measured at a 6-mm radius from the corneal center, and the I-S thickness difference was calculated. Pearson’s correlation coefficient was used to analyze the relationship between age and the I-S thickness difference. Data were analyzed statistically, with significance set at P < 0.05.

Post-DMEK eyes exhibited a significantly higher mean I-S epithelial thickness difference of 7.40± 6.43 μm, compared to 2.97± 2.2 μm all eyes (p<0.01), 3.15± 2.20 μm in the right eye (p=0.01) and 2.77± 2.12  μm in the left eye (p<0.01) of the control group. No significant correlation was found between age and the I-S difference in either group (r = 0.26 , p=0.27) for controls, r = 0.21, p=0,12 for post-DMEK). The findings suggest that DMEK does not significantly alter the natural epithelial thickness distribution, though minor surgical or healing-related changes may contribute to increased I-S differences in post-DMEK eyes.

The inferior corneal epithelium remains thicker than the superior region post-DMEK, suggesting that epithelial remodeling follows a predictable course. No significant correlation was found between age and I-S thickness differences. These results contribute to understanding epithelial remodeling post-DMEK and may have implications for postoperative management.